Individual provider Active NPI

Priyantha Nalinda Wijewardane, M.D.

  • Internal Medicine Physician
  • Little Rock, AR
National Provider Identifier
1104811108
Registry record updated Dec 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E-1124 Issued in AR
Practice address
1505 W 11TH St
Little Rock, AR 72202-4619
Phone
(501) 376-1160
Fax
(501) 376-3977
NPI assigned
Sep 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E-1124 AR Primary

Addresses

Primary practice location

1505 W 11TH St
Little Rock, AR 72202-4619

Mailing address

1505 W 11TH St
Little Rock, AR 72202-4619
Phone (501) 376-1160

Other identifiers 1

IdentifierTypeStateIssuer
130532001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100412000096 AR Practitioner - Internal Medicine 7012043565 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

1701 Club Manor Dr
Suite 2B
Maumelle, AR 72113-7401
Phone (501) 851-7402

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-1124ARMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health CurrentSince Jan 13, 2020 Accepting new patients
Arkansas Health Group CurrentSince Feb 6, 2017 Accepting new patients
Baptist Health CurrentSince Jan 13, 2020 Accepting new patients
Arkansas Health Group Internal Medicine CurrentSince Feb 6, 2017 Accepting new patients
Pope Physician Services LLC Past Accepting new patients

Locations

9601 Interstate 630
#7
Little Rock, AR 72205
Phone (501) 202-3995

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

9601 Baptist Health Dr
Little Rock, AR 72205
Phone (501) 202-3995

1701 Club Manor Dr
#2B
Maumelle, AR 72113

1701 Club Manor Dr
Ste 2B
North Little Rock, AR 72113
Phone (501) 812-7216

3333 Springhill Dr
North Little Rock, AR 72117
Phone (501) 202-3000

1701 Club Manor Dr
Ste 2
North Little Rock, AR 72113
Phone (501) 202-4088

Interoperability endpoints

  • Direct secure messaging: pwijewardane2589@direct.baptist-healthar.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261526400000",
    "number": "1104811108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 W 11TH ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722024619",
            "telephone_number": "501-376-1160",
            "fax_number": "501-376-3977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W 11TH ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722024619",
            "telephone_number": "501-376-1160",
            "fax_number": "501-376-3977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIJEWARDANE",
        "first_name": "PRIYANTHA",
        "middle_name": "NALINDA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2009-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-1124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130532001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.